Stanley John Antolak Jr., M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

16329 Issued in MN

Practice address

7400 France Ave S
Suite 100
Minneapolis, MN 55435-4738

Phone

(763) 537-6000

Fax

(763) 537-6666

NPI assigned

Mar 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 2, 2016 through Jun 2, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stanley J. Antolak Jr. MD PA

  • Specialist
  • Lake Elmo, MN
  • NPI 1508930512
  NPD (past) Authorized official
• Mayo Clinic

  • Clinical Medical Laboratory
  • Rochester, MN
  • NPI 1083249577
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233705600000",
    "number": "1881663169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 NORTHDALE BLVD NW",
            "address_2": "SUITE 220",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554333028",
            "telephone_number": "763-537-6000",
            "fax_number": "763-537-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 FRANCE AVE S",
            "address_2": "SUITE 100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554354738",
            "telephone_number": "763-537-6000",
            "fax_number": "763-537-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTOLAK",
        "first_name": "STANLEY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2009-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "16329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Ongaro DDS PA
• Caroline Sibongile Anthony, MENTAL HEALTH PRACTI
• Helen Anthony, PHD LP
• Lauren L. Anthony, M.D.
• Christopher Milton Antolak, MD
• Emmanuel S. Antonarakis, M.D.
• Natalie Antonson
• Sara Marie Antonson, LMFT
• Kristin Marie Anttila, MSW, LICSW
• Tessa Evelyn Anttila, LICSW

• Urology Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Urology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.